Individual
ALISSA RODGERS DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
21 GAMECOCK AVE STE E, CHARLESTON, SC 29407-3368
(843) 763-9664
(843) 763-2949
Mailing address
779 CONDON DR, CHARLESTON, SC 29412-4703
(843) 795-6366
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A982
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0337PA
—
SC
Enumeration date
06/29/2006
Last updated
07/08/2007
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